Creative Case Management Blog

Preventing Alzheimer's by Being Active

ccbishop@creativecasemanagement.com (Charlotte Bishop) — Wed, 16 May 2012 23:57:00 GMT

What costs relatively little, is accessible to virtually all individuals regardless of age, is safe and helps to prevent the onset of a medical condition that adults almost universally fear? The answer is that physical activity – of all kinds – turns out to be an effective way to delay or even prevent the onset of the form of dementia we refer to as Alzheimer’s.

Scientists have long known that a person whose muscles get a regular workout and are generally active are actually generating new neurons in their brains. New research now shows that it is not just about exercising and working up a sweat that will confer this benefit; virtually any kind of activity is good for the brain and measurably reduces the incidence of Alzheimer’s. Research published this year has shown that basic activities like housework or yard work are linked to a lower incidence of Alzheimer’s. So, washing dishes, doing the laundry, dusting the furniture, pruning the bushes and more actually have a tangible mental health benefit.

The scientists who did the research followed more than 700 older patients who started the study with no initial signs or symptoms of Alzheimer’s Disease. Through a combination of actual measurement of these individuals’ daily activities along with the patients’ own reports of what they did and for how long, scientists kept logs on them for four years. The actual measurement was in the form a wrist sensor that tracked movement and its duration. The average weekly physical activity for the whole group of older adults was about 3.3 hours per week.

Those who were in the bottom 10 percent of the panel who were studied were more than twice as likely as the others to develop Alzheimer’s by the end of the four years. In fact, about ten percent of the total number of individuals did develop Alzheimer’s during the course of the research.
This relationship ship between physical activity and delaying Alzheimer’s held across a range of other medical conditions like obesity, depression or even cardiovascular risk factors.

Even those patients with a gene known as a high risk for Alzheimer’s did better with more activity. So, if you have an older adult in your orbit who wants to work against Alzheimer’s they do not have to go to a gym. Just encourage them to pick up a rake or a broom or just do their own dishes or make the bed.

This research was carried out here in Chicago through the Memory and Aging Project at Rush University Medical Center and was published in the professional journal Neurology.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to Charlotte Bishop.

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Tags: preventing alzheimer's; geriatric care Chicago; geriatric care manager Chicago

Six Tips for Avoiding Drug Reactions in Elders

ccbishop@creativecasemanagement.com (Charlotte Bishop) — Mon, 07 May 2012 14:40:00 GMT

According to the Centers for Disease Control (CDC) adverse drug reactions or overmedication result in more than 700,000 hospitalizations a year. And many of these could be avoided by following advice offered by the American Geriatrics Society. The AGS’s Foundation for Health in Aging offers advice for all of us who care for older parents or adults in our orbits. Here is a summary of the six major recommendations.

Ask before taking OTC drugs: Never assume that just because you can buy a medication in a drug store without a prescription that it will be harmless. Most of these drugs started out as prescription meds. Ask the doctor or pharmacist if an OTC drug is a risk by itself or in combination with a prescription your elder may already be taking.
Make/update your List: A lot of medical offices are very good about asking patients on every visit what medications they are taking and keeping it in their records. With every visit the provider needs to add new medications so that everyone is aware of what your elder is taking.
Question your provider: When you or your elder receive a new prescription ask questions about when to take the drug, with or without food, what to do if a dose is missed, is it available in generic form and what are the common side effects?
Read the labels and follow them: There is a fine print insert of patient instructions that comes with every prescription. Don’t be intimidated by the scientific jargon; look for the indications and usage section as well as the adverse events sections. And then take them as directed – don’t add a dose for better effect or stop just because you feel better.
Report any ill effects: There is a saying in geriatric circles that every symptom in an older adult should be considered a side effect of a drug until proven otherwise. Especially if there is sudden difficulty breathing or swallowing, light-headedness or irregular heart beat. If you cannot reach your loved one’s provider call 911.
Review your medications with your provider: At least once a year you should talk with your elder’s provider about the medications, the doses and any changes you may have noticed. And do not leave out vitamins, supplements or herbals.

For more information go to the American Geriatrics Society web site as well as refer to a list of drugs that have known side effects or other issues. This is called the Beers List .

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to Charlotte Bishop.

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Tags: older parent Chicago; geriatric care Chicago; geriatric care Chicago; drug reactions

May is National Geriatric Care Manager Month

ccbishop@creativecasemanagement.com (Charlotte Bishop) — Wed, 02 May 2012 14:22:00 GMT

May is National Geriatric Care Manager Month, but I am thinking that most of you probably did not get the memo. You may have been following my blog – especially those with an older parent or loved one – and you know what it means to be a caregiver, but not as many may know what a geriatric care manager (GCM) is. Geriatric care managers are the people who work with caregivers to older parents who want time for their own families and confidence that their mom or dad will be well cared for. We also work with older adults who do not want to be a burden to their families as they navigate health care issues and make decisions about where and how they can live as independently as possible.

And a person does not have to really be a caregiver to seek the services of a geriatric care manager. We also work with professionals who want to get help for their aging clients when they have had a life-changing incident and wish to remain as independent as possible. These are professionals who want to help their clients maintain quality of life when life changes and coordinate the medical and other resources that make that happen.

I sum up what it is to be a geriatric care manager by describing the four activities where I am most involved in helping elders or others with special needs:

Resource: GCMs make the home of a loved one who is aging in place more secure. We help show families what services can be brought to an elder’s home and at some point identify what are the best alternatives to home. And quite often with sandwich generation adult children of older adults, we can be there at a doctor’s appointment when they cannot be there.
Counselor: GCMs help families to reach consensus about how to best care for mom or dad when there are so many options or in cases where it may seem that there are no good choices. We help caregivers to older adults or even spouses to sort out whether it is just tiredness or if it is depression or old age.
Advocate: GCMs help to coordinate the care from multiple medical specialists who may be attending to an older adult and make sure they are all communicating with one another and with the caregiver. We also work to document a clear care plan the helps to preserve the life an older adult really wants, and we are the eyes and ears to look out for what is best for an elder if they are living in a senior community, assisted living or nursing home. We are particularly alert to any signs of abuse or exploitation.
Friend: GCMs are also good listeners, because it can be really important that a caregiver have someone with whom they care share how hard it really is to reverse roles with the parent who had raised them from childhood. It helps for me to have been a caregiver, so I can personally and professionally empathize with what it is like.

For more information on geriatric care management visit Care Manager.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to Charlotte Bishop.
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Tags: geriatric care Chicago; geriatric care manager Chicago; older parent Chicago; older parent Illinois

When a Caregiver's Touch is Key

ccbishop@creativecasemanagement.com (Charlotte Bishop) — Fri, 27 Apr 2012 15:52:00 GMT

In an age of high tech health care, it is really gratifying to know that something as simple and personal as human touch can make a difference in the life of an older person. By stimulating the receptors that are just beneath skin, massage can bolster an individual’s immune system, reduce their stress level and generally improve their mood and sense of well-being. Gentle massage of an older person also will improve their blood circulation, ease their aches or pains and enhance their emotional outlook.

Anyone who has raised kids knows that sometimes it is just a hug, a kiss, or a gentle touch that takes away the stress or hurt of an infant. And we all know that holding hands, a pat on the back or a kindly touch conveys so much in the way of a feel good to another person with whom we want to connect. So, if you have an older person in your orbit, try one of these four approaches to enhance their health and well-being:

Compression and Release – starting at the wrist and working your way up a person’s arms gently compress and then release. And if they will allow you to touch their feet and legs, work on those extremities also.
Hand to Hand – the same basic approach can be applied to the hands. Using your palms you can gently compress and release each of the digits and work your way to their palms.
Touch the Soles – poor circulation in the feet that comes from less walking in older adults can be relieved by loosening the feet’s connective tissue using your thumbs to gently massage the bottoms of their feet.
Back to Back – being careful not to put pressure on bone, use the palm of your hand to work in circles from the sacrum and up the spine. It relieves the tension in muscles that cause backache and limit range of motion.

It is important with an older recipient of your massage that you remember that they are in fact old, and that their tissue requires gentle attention. It will not be one of those deep massages that a younger person might seek at the spa.

Older skin is more prone to bruising or even tearing, so start soft. Use lotions that are not sticky to avoid any tearing of the skin.
Be aware of the medications that the person may be taking as some meds like blood thinners will make them particularly susceptible to bruising.
And diabetics will have greater loss of sensation of their feet or hands so they may not even be able to tell you when you are bruising their extremities.
Avoid pressure on bones will be really important if your older person has been diagnosed with osteoporosis.
Also avoid open wounds so that you don’t start or spread an infection.

Finally, it is important to remember that massage is an intimate experience that not every older person will immediately accept. Get their permission, and maybe even start with an invitation to take the excess lotion from your hands as a warm-up to sharing the benefits of touch. And remember that as you touch the person, you also are touching their heart.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to Charlotte Bishop.
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Tags: massage,older person,geratric care Chicago,geriatric care manager Chicago,older parent

Advice from the Perspective of 100

ccbishop@creativecasemanagement.com (Charlotte Bishop) — Mon, 16 Apr 2012 20:57:00 GMT

This marks the 100^th posting on our blog since its inception October, 2010, and it gave me pause to stop and reflect on what one learns at 100. So, whom better to ask than people who have had 100 birthdays, made it to that milestone and have been paying attention along the way. I have gathered together here a short compilation of wisdom from some centenarians whom I felt had something to offer the rest of us. You tell me what you think.

Ruth offers advice on life and style. Appreciate that Ruth lifts weights everyday and practices Pilates weekly, an activity she just picked up when she was 92. Perhaps her most memorable piece of advice is about time and age; she says, “Don't look at the calendar just keep celebrating every day.” This, from a lady who does not wear blue jeans and makes herself get up and out every day for at least a short walk. (And she is a real believer in the values of skin moisturizer.)

Ephraim is a doctor still in practice at age 100 His advice to all of us starts with choices. The two important choices that top his list include “choosing the right parents” and then “choosing the right spouse.” The doctor still has a sense of humor, and you will appreciate that if you go to his site to see the rest of his advice which include “keep breathing.”

Jessie is the other side of 100 at 105. She commends that peace is the root of happiness. She does not count her time in years, but rather in minutes and the promise that each minute holds for her. She also stays active and only just recently gave up her favorite activity, swimming, at the age of 101.

Patsy is a quiet man at age 100. His secret is to simply enjoy life. Part of that includes his weekly treat from the local pizzeria, one slice of thin crust sausage pizza. And when he is asked what he means by enjoy, he responds: “I like to be sociable with everybody.”

Fauja finished the Toronto marathon last year. This stands as a Guinness record, and Mr. Singh was very excited to make the distance on behalf of local charities. Perhaps the secret to being able to run that far at age 100 is to not start, as Mr. Singh did, until you are 80 years old and also to surround yourself with friends as Fauja did for his run.

So, the common thread? Maybe the lesson we can take from centenarians is that it is not about a destination as much as it is about a journey. It is not about having lived to 100; it is about having lived each day along the way.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com .

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Tags: older parent,geriatric care Chicago,geriatric care manager Chicago,100 years,elder care

Five Tips for Preventing Bedsores in Elders

ccbishop@creativecasemanagement.com (Charlotte Bishop) — Fri, 13 Apr 2012 02:30:00 GMT

Health care providers call them decubitus ulcers, but most people know these pressure wounds on the skin as bedsores. Although bedsores as a medical condition are not tracked by the Centers for Disease Control, it is generally estimated that about two million Americans suffer with these ulcers any given year. The vast majority of pressure ulcers occur among adults in their 70’s or 80’s, but the real cause is not age; it is lack of mobility. An unfortunate – and high profile – case in point was the late actor, Christopher Reeve. He did not succumb to his paralysis, per se. He died of a systemic infection that began in a pressure ulcer in 2004.

But older adults are the more common victims of bedsores for a lot of reasons. They have more fragile skin to begin with, a natural outcome of aging. They also tend to be less hydrated and have relatively poorer nutrition, both conditions which make for less healthy skin and for poorer circulation and healing if there is a wound. Elders who may be bed ridden or confined to a wheelchair also are less likely to move themselves enough to take pressure off their skin. Bedsores result when there is enough pressure between a bony mass and the skin beneath it. The resultant poor circulation deprives the skin of sufficient blood flow that a portion of the area may be starved of oxygen and nutrition and simply dies. It starts out as a reddened area, but can quickly progress to a deep wound that may form a hole that goes all the way to the bone below the skin surface.
So why don’t babies or infants get bedsores with all the lying about and sleeping that they do? And how about teens? Very simply, younger individuals are on the move constantly. Even when asleep, researchers have found that a healthy individual will shift position about once every fifteen minutes. A rolling stone may gather no moss, and a sleeping youth will gather no ulcerations.
If you are a caregiver to an elder who may live in a nursing home, see to it that the providers on the job are being duly attentive to your loved one. Here are five things providers should be doing to avoid pressure sores:

On admission to a nursing home or if a patient becomes hospitalized, they should be evaluated for their bedsore risk; there is an actual scale called the Braden Scale that providers should use.
An older adult’s skin should be regularly cleaned and always kept appropriately dry; however, there are times when moisturizer may be called for.
Make sure that your loved one gets plenty of water and nutrition; this will make for healthy skin.
See that your elder is helped by a team that includes nurses and nutritionists, but also even beauticians and laundry workers.
In addition to having an appropriate sleeping surface, the older adult needs to be repositioned frequently, especially if they have mobility issues that make it hard to move themselves.

Tags: older parent Chicago,geriatric care Chicago,geriatric care manager Chicago

Six Cautions on Drug Food Interactions Among Elders

ccbishop@creativecasemanagement.com (Charlotte Bishop) — Tue, 03 Apr 2012 14:42:00 GMT

We all have heard it said that we are what we eat, but something that many of us do not always think about is how the foods we eat may not mix with the medicines we take. And this becomes the potential for a perfect storm of medicines and foods among older adults. Their bodies do not eliminate food or drugs as quickly; they typically have a lower body weight; and they have lower water content in their bodies. All of these magnify the problems that younger adults may face, because anything they ingest becomes more concentrated.
It also is an even more likely to be an issue with older adults because research shows that four out of five people over age 57 are on at least one prescription, and half also are taking some medicine or herbal supplement they have bought over the counter. Thirty percent of older adults take more than five prescription drugs.
Computerized medical records make it a lot easier for health care providers today to avoid drug-drug interactions in their patients, but not all of them warn of the interactions between certain foods and medicines. So, here are some tips to help an elder or other person with special needs for which you may be a caregiver:

With some antibiotics, like tetracyclines, it is important to not take any dairy products at the same time with them, because it can cause stomach upset.
If your elder takes one of the blood pressure meds referred to as ACE inhibitors which contain potassium, be careful about eating a lot of bananas, oranges or leafy green vegetables that are high in potassium-too much potassium can cause irregular heartbeats.
For some of the cholesterol-lowering statins, you should avoid taking in grapefruit juice as it can exaggerate the statin’s side effects.
For someone taking certain medications that treat depression called monoamine oxidase (MAO) inhibitors, eating large amounts of chocolate can raise blood pressure.
MAOs also do not agree with salami, bologna, pepperoni or certain aged cheeses for the same reasons; they can elevate blood pressure.
If your elder loved one takes a blood thinner like Coumadin, be careful with foods high in vitamin K like broccoli, cabbage or spinach as they can negate the effect of the blood thinner.

As a caregiver, help the elder for whom you care to keep an accurate list of all their prescriptions as well as vitamins and supplements they may take. Make sure you share the list with their health care provider, and read the drug information that your elder may receive from the pharmacist when filling prescriptions. The U.S. Food and Drug Administration also can be an invaluable resource on food and drug as well as drug-drug interaction that you should know. Check out the FDA web site.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to Charlotte Bishop.
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Tags: caregiver,geriatric care Chicago,geriatric care manager Chicago

Watch for Signs of Elder Abuse

ccbishop@creativecasemanagement.com (Charlotte Bishop) — Thu, 22 Mar 2012 14:38:00 GMT

One to two million Americans 65 years of age and older suffer from some form of physical, financial or mental abuse. The figures are not precise, because so many cases of abuse go unreported, and abuse can take on many forms from physical injury, to financial exploitation to neglect. The real tragedy is that most abuse comes from those who are caregivers to an older adult, those who are supposed to be helping – not hurting.

Be vigilant for elder abuse by knowing the most likely victims of abuse:

A large share of abused elders are what we term the “old – old;” they are over the age of eighty, and while they may not be frail, they cannot as readily defend themselves or even seek out help.
Abused elders are more likely to be women than men.
The victim is most often a person who depends on the abusive individual for basic needs; it is most typically not a stranger.
The victim also may be suffering from a mental illness such as some form of dementia that gets in the way of their protecting themselves or being taken seriously if they complain.

It is also important to know the classic profiles of abusive individuals:

Usually the abuser is a family member, the spouse of the victim or an adult child or other relative in the elder’s orbit.
The abusive caregiver also may be under stress; caregivers who have their own personal or financial challenges are primed to be abusive.
Whether a caregiver or not, the abuser is more likely to have some dependency issues like drug or alcohol abuse.
As much as the elder may depend on a caregiver, the caregiver may also be financially dependent upon the elder, especially for money or housing.
Finally, it is important to know what signs to look for.

While professional such as health care providers, police or social service agency personnel are required by law to report suspected abuse, we all should be alert. The signs of abuse you can look for:

Bruises that may be explained away as a fall;
Burns that they may say was a kitchen accident;
Bedsores from a non-ambulatory elder;
Onset of depression;
Sudden change in financial ability;
Loss in weight or in some cases weight gain;
Any behavior out of the ordinary; or
Caregiver arguments with other people.

And remember above all, that an abused elder may choose to suffer silently, because speaking out may jeopardize the care they receive. Or they simply may not want to get the caregiver in trouble. There is help. If you suspect elder abuse, check out the web site of the National Center on Elder Abuse.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to Charlotte Bishop.

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Six Brain Healthy Tips for Elders

ccbishop@creativecasemanagement.com (Charlotte Bishop) — Fri, 16 Mar 2012 17:49:00 GMT

March is Brain Awareness Month.

It gives us all a reminder to nourish our neurons and soothe our synapses, and this is even more important for older adults. A person’s brain may have more years of use, but that does not mean there is not a lot within every person’s individual control that can help the brain function at its best at any age. Here are five suggestions for helping your brain or that of an elder in your orbit to be as brain healthy at 80 as at eighteen...okay 48:

What you eat: A lot of really medical solid research in recent years has shown that “we are what we eat” at every age. Older adults will benefit from a diet heavily populated with protein, antioxidants-folic acid is a concentrated source, omega-3 fatty acids-in fish, fruits and vegetables and vitamin B. It is important to stay light on the carbs and trans fats as well.
Active is more than sports: We all appreciate that a person who physically works out typically will have a healthier, robust physique. The same is true of the brain. If an older adult does not engage in stimulating games, conversation or other activities, the brain can get the neural equivalent of flabby. Give the brain a work out daily.
Be sociable: Pity the older adult who retires and just sits at home in front of a television all day. Socializing keeps the brain active along what the rest of the body. It also reduces the stress we all can accumulate, old and young alike. And one of the great benefits of sociability is the chance to share a good laugh…it is great medicine.
If you Snooze you win: It is ironic that one of the best things to do for an older brain also can be one of the hardest to find. Getting a good night’s sleep allows all the parts of the body to repair themselves. The opposite is true also…poor or less sleep negatively impacts the brain.
Don’t stress: Stress is not just hard on the cardiovascular system of an older adult. It also accumulates chemicals in the brain than may damage brain cells and interfere with an older person’s ability to think clearly and effectively. So don’t just get sleep, unload the stressors every day.
It is more than a brain: And wholistic medicine teaches us that everything affects everything. Cardiovascular health (through hypertension of other issues) will impact brain health as well as pancreatic health (ala diabetes) and even elevated cholesterol. An older adult will have a healthier mind if the body that it rides around in also is fit.

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When it is NOT Alzheimer's

ccbishop@creativecasemanagement.com (Charlotte Bishop) — Thu, 08 Mar 2012 21:53:00 GMT

If you take a straw poll of any gathering of older adults or their caregivers you are likely to find that what they fear most is not their death, but their loss of their mental faculties. Yet, about one in every four persons who begins to manifest that cloudy thinking we all fear is some form of dementia may actually have a reversible condition. And this condition may be brought on by allergy medications or some other prescriptions as well as some over the counter medications.

Researchers from the Alzheimer’s Association have reviewed studies from large clinics around the country and report up to 25 percent of people who come to specialists fearing they have dementia really are suffering from bad medicine instead. Most often the culprit is a family of drugs referred to anticholinergics, drugs that are common to a wide range of medications ranging from anti-depressants and pain killers to antihistamines. And the cloud that they create in a person’s mind usually is the result of side effects of the medications.

The problem is particularly acute among older adults for a number of reasons. First, older adults are more likely to engage in polypharmacy, the situation in which a person with more than one medical condition may therefore be on more than one medication. Second, older adults have lower water content in their systems and tend to flush medications out of their system a lot more slowly. And third, older adults also may be taking over the counter medications in addition to what may be prescribed by their providers.
Sadly, these medicines may be creating more than a fog for older adults; it may also be killing them. In a study reported in The Journal of the American Geriatrics Society, researchers gathered clinical data and followed more than 13,000 British men and women 65 years of age and older. Those who were taking more than one of the drugs in this class of medicines tended to score lower on cognitive tests than those who did not take anticholinergics. Alarmingly, they found that the death rate among the heavier users of these drugs was 68 percent higher than the others.

In America, it is estimated that about one in five of the 36 million adults 65 years of age and older are taking one of these medications. And other research shows that taking one of these medications for only 90 days can have a measurable impact on cognitive function.
So, the lesson from all this is to steer clear of this class of medications where possible. But even short of that make sure your older loved one’s primary care provider knows about all medications the patient is taking – prescription and non-prescription. There may be no steering clear of anticholinergics totally, but we all can keep from adding more to our load by taking over the counter drugs that contain it.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to Charlotte Bishop.
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Tags: Alzheimer's,geriatric care Chicago,geriatric care manager Chicago